Antipsychotics Management in Addictive Disorders

Pierre   Alexis   Geoffroy; Benjamin      Rolland; Vincent      Laprevote; Olivier      Cottencin

Abstract

Several authors have hypothesized that antipsychotics could down-regulate the activation of dopamine receptors in the mesolimbic pathway, thus decreasing the occurrence and the intensity of addiction-related symptoms. We conducted a critical review of the theoretical arguments that have been published on this subject and evaluated how they compare to the published clinical data. Despite interesting findings, the effects of antipsychotics may not be as compelling as what would be theoretically expected. Thus far, antipsychotics have shown no efficacy in treating addictive disorders alone. Nevertheless, effective strategies for the use of antipsychotics against addictions are available and discussed. To treat individual vulnerability factors to addictions, such as psychiatric comorbidities (schizophrenia or bipolar disorder) that share vulnerability factors with addictive disorders and contribute to triggering addictive behaviors are among the strategies. The evidence for using antipsychotics is still the best in subjects with comorbid schizophrenia and alcohol or substance use disorder. Additionally, in some clinical situations of major impulsivity, the off-label prescription of atypical antipsychotics is worth exploring, but should be further investigated in a clinical setting.

Keywords: Antipsychotics, addiction, comorbidity, impulsivity, reward system, substance use disorder.